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D Jolly

Publications and source records attributed to D Jolly.

At least 55 records · Page 3Linked to original sources
PubMed1995

Health promotion in France. Toward a new way of giving medical care.

Health promotion is not a concept often encountered in France, especially in university teaching hospitals. In fact, the spontaneous orientation of healthcare services tends to emphasize high-technology care, rather than preventive care. This article describes the main characteristics of the French healthcare system, some new elements of its health policy, and a specific experiment of health promotion in a new geriatric hospital.

Aged↗
PubMed1995

Recombinant retroviral vector interferes with the detection of amphotropic replication competent retrovirus in standard culture assays.

Many protocols for gene therapy employ recombinant retroviral vectors, which are replication-defective retroviruses engineered to serve as gene delivery vehicles. The use of retroviral vectors for human gene therapy requires careful screening of vector-producing cell lines and culture supernatants to ensure the absence of replication competent retrovirus (RCR) in clinical products. In this study we have examined several different culture assays routinely used to test for the presence of RCR. Results indicate that cocultivation of a vector-producing cell line with a permissive cell line can reproducibly detect a low level of contaminating RCR. RCR was detected less frequently in direct tests of cell-free culture supernatants from a contaminated vector-producing line. Further studies revealed that recombinant retroviral vector can interfere, to varying degrees, with the detection of low-level RCR in culture supernatants when a marker rescue assay, an extended mink S+L- assay or a PG-4 S+L- assay is used. Interference can be partially overcome by culturing the vector preparation with a permissive cell line for several days before testing on the indicator cell line. The interference phenomenon we have observed may also occur in other culture assays routinely used for the detection of RCR.

Animals↗
PubMed1994

[Cardiac anomalies in disseminated lupus erythematosus diagnosed by Doppler ultrasonography. Prevalence and association with antiphospholipid syndrome].

OBJECTIVES: Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are widely associated with thrombosis, recurrent abortions and a thrombocytopenia. The purpose of this study was first to evaluate the prevalence of cardiac abnormalities in patients with SLE and secondly to establish the relationship between the findings and the presence of an antiphospholipid syndrome. SUBJECTS AND METHODS: First of all, a total of 52 consecutive patients with SLE and 52 healthy sex-and-age-matched control subjects were evaluated in a cross sectional study. All underwent M mode and two dimensional echocardiography, color flow imaging, pulsed and continuous wave Doppler. Secondly, in the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to the control subjects. RESULTS: Compared with the control group, patients with SLE had significantly more pericardial abnormalities [(p = 0.0006) RR [3.36-infinity], mitral regurgitation [(p = 0.032) RR 2.48 [1.25-5.6]], tricuspid regurgitation [(p = 0.0016) RR 2.41 [1.58-8.85]. There was no significant difference between both groups for the left ventricular mass (p = 0.07), posterior wall (p = 0.25) and interventricular septum dimension (p = 0.16), and mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased left ventricular mass (p = 0.0054), posterior wall (p = 0.022) and interventricular septum dimension (p = 0.026). The relative risk increased for tricuspid and pulmonary regurgitation in SLE patients who had the antiphospholipid syndrome. CONCLUSION: The prevalence of left ventricular hypertrophy and right heart valvular regurgitation is significantly raised in SLE patients who have the antiphospholipid syndrome. However, antiphospholipid syndrome does not modify the prevalence of pericardial abnormalities which seems to be due to SLE alone.

Adult↗
PubMed1994

Recombinant retroviral vector delivered intramuscularly localizes to the site of injection in mice.

A murine retroviral vector encoding the human immunodeficiency virus type 1 (HIV-1) env and rev genes can be used to induce cytotoxic T lymphocyte responses. Immune responses can be induced by an ex vivo treatment, in which autologous cells are transduced in vitro and re-introduced to the donor, or by direct administration of retroviral vector via intramuscular injection. In this study we have used polymerase chain reaction (PCR) analysis to examine the distribution of recombinant murine retrovirus directly administered to mice. Mice were injected intramuscularly with HIV-IT(V), an amphotropic murine leukemia virus (MLV)-based retroviral vector carrying the HIV-1 env/rev genes and a neomycin resistance marker gene. Detection of the HIV-1 env gene in DNA isolated from injection sites demonstrated in vivo transduction. No evidence of transduction was observed in the testes, spleen, kidney, or thymus. Retroviral DNA was detected in the liver of one animal in the study. These data suggest that retroviral vector administered intramuscularly to mice localizes primarily to the site of injection and that measurable transduction in the testes does not occur.

Animals↗
PubMed1994

Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study.

Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are often associated with thrombosis, recurrent abortions and thrombocytopenia. The purpose of this study was to evaluate the prevalence of cardiac valvular abnormalities in patients with SLE and to establish the relationship between the echographic findings and the presence of an antiphospholipid syndrome. A total of 52 consecutive patients with SLE and 52 healthy sex- and age-matched controls were therefore evaluated in a cross-sectional study. All underwent M-mode and two-dimensional echocardiography, color-flow imaging, pulsed and continuous-wave Doppler. In the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to controls. Patients with SLE had significantly more mitral (p = 0.032; RR 2.48; 1.25-5.6) and tricuspid regurgitations (p = 0.0016; RR 2.41; 1.58-8.85). There was no significant difference between either group for mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased relative risk for tricuspid.

Adolescent↗
PubMed1994

Genetic risk factor in primary open-angle glaucoma: a case-control study.

PURPOSE: To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environmental risk factors. METHODS: A case/control study was carried out using 175 POAG patients and 175 controls, all Caucasians of at least 40 years of age. The diagnosis of POAG was established based on the presence of characteristic defects in the visual field and on glaucomatous cupping. The presence of risk factors was established by means of a questionnaire. RESULTS: Using a conditional logistic regression, we found that a family history of POAG in first-degree relatives was a major risk factor (OR = 7.67; 95% CI: [3.25-18.1]; p < 10(-5)). We found no link between diabetes and POAG, high blood pressure and POAG, heart disease and POAG, myopia and POAG, or the use of alcohol or tobacco and POAG. CONCLUSION: Our results indicate a strong genetic influence in the development of POAG and suggest the hypothesis of a polygenic or multifactorial mechanism.

Adult↗
PubMed1994

Erythrocyte aggregation--determination of normal values. Influence of age, sex, hormonal state, oestroprogestative treatment, haematological parameters and cigarette smoking.

Erythrocyte aggregation is a physiological phenomenon and constitutes one of the most important factors accounting for the non-Newtonian properties of normal human blood. Pathological aspects have also been described and therapy aimed at reducing hyperaggregability has been proposed. The object of this study was to establish normal values of erythrocyte aggregation parameters as measured by laser light backscattering and to study the influence of various physiological factors. Normal values were determined from a reference population. Sex and age induce variations in erythrocyte aggregation which are neither fibrinogen nor haematocrit dependent and there is a general trend towards stronger aggregation in women, although neither hormonal state nor oestroprogestative treatment appear to influence the female aggregation parameters. In elderly people stronger aggregation is also observed but this effect is of lower magnitude. In vivo, the plasma fibrinogen level is the most important factor influencing erythrocyte aggregation, while variations in haematocrit play a lesser role and mean corpuscular volume, red cell distribution width and white blood cell and platelet counts have no effect. Finally, no difference is noted in cigarette smokers.

Adolescent↗
PubMed1994

Approach to erythrocyte aggregation through erythrocyte sedimentation rate: application of a statistical model in pathology.

Erythrocyte sedimentation rate (ESR) is mainly used in clinical practice as a screening test for inflammatory diseases and sometimes in the follow-up of patients. However, ESR is highly dependent on erythrocyte aggregation. In this study, using a Sediscan (Becton) automatic device measuring the kinetics of ESR, these results are compared with the measurement of erythrocyte aggregation as determined by laser light backscattering (Erythroaggregometer Affibio). A series of 188 samples from in-patients were tested. Statistical analysis of 13 parameters indicates that 82% of ESR variance may be explained by fibrinogen level, haematocrit and a parameter characterizing erythrocyte aggregation: the aggregation index at 10 s. This correlation was then validated prospectively in 128 other patients and seems to be independent of the underlying disease. Thus ESR in combination with fibrinogen assay and haematocrit may be considered as a simple and economic method to assess erythrocyte aggregation.

Blood Sedimentation↗
PubMed1994

[Initial prognostic factors of aneurysmal subarachnoid hemorrhage].

The purpose of this retrospective study is to explain, using a total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage, the survival by several prognostic factors measured at the admission time. A multivariate analysis using the Cox proportional hazards model allowed one to recognize five prognostic factors: secondary arterial hypertension (risk ratio (RR) = 1.8; p = 0.03), the Hunt and Hess grade-3 (RR = 3.3; p = 0.002), the Hunt and Hess grade-4 (RR = 7.3; p = 0.007), and the hunt and Hess grade-5 (RR = 5.8; p = 0.03), the Fisher grade-3 (RR = 2; p = 0.01), and the Fisher grade-4 (RR = 2; p = 0.001). The determination of a prognostic score for each patient (using the coefficients of selected prognostic factors) allowed one to establish 3 prognostic stages with survival probabilities significantly different (p = 0.00005); stage-1; survival rate after 150 days (SR) = 97 %, confidence interval of 95 % (CI) = [0.90; 0.99], stage-2: SR = 66 %, CI = [0.56; 0.74], stage-3; SR = 34 %, CI = [0.17; 0.54]. The relative death risk for the stage-2 was 14 times higher than that for stage-1 (p = 0.00005), and the relative death risk for the stage-3 was 36 times higher than that for stage-1 (p = 0.00005). The age, the essential arterial hypertension, the sex and the angiographic classification of George have no prognostic value. The rebleeding incidence was correlated with prognostic stages (respectively from stage-1 to the stage-3: 8 %, 14 %, 34 %).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Evaluation of the frequency of acute renal insufficiency and therapeutic modalities in the nephrological milieu].

Due to lack of structured epidemiological studies, the incidence of acute renal failure (ARF) cannot be established in France. An empirical approach method based on answered questionnaire sent by mail to nephrology centers affiliated or not to universities has been used to estimate the frequency of ARF requiring dialysis in 1991. We postulated that the French population was homogeneously distributed among the different regions and that the response rate of 74% could be extrapolated to 100%. We could therefore calculate an incidence of 64 ARF per million of inhabitants. However, this underestimates the exact incidence since the accurate evaluation of IRA in a controlled region (Champagne-Ardenne) is 104 per million of inhabitants. In addition, this study underlines the fact that many ARF are not treated in nephrology units, especially those associated with multiorgan failure requiring slow continuous hemofiltration and hemodialysis. It is suggested that the establishment of a national Registry for ARF and an adequate training of nephrologists are prerequisites to assess epidemiology and the global cost of ARF.

Acute Kidney Injury↗
PubMed1993

What factors determine indium-111 antimyosin monoclonal antibody uptake in patients with myocardial infarction?

The intensity of indium-111 antimyosin monoclonal antibody uptake for visualization of myocardial infarction seems partially dependent on the state of the infarct related coronary artery. The aim of this study is to determine the factors which could account for the monoclonal antibody uptake variability. For this purpose, we investigated 27 patients (mean age 52.7 +/- 9.6 years) with a first proven myocardial infarction, by monoclonal antibody scintigraphy and coronary arteriography within the same period of time (7.12 +/- 6 days). The monoclonal antibody uptake was quantified by the heart/lung ratio on images recorded 24 h after injection. The infarct size was quantitatively estimated on wall motion analysis of twelve segments in 30 degree right anterior-oblique view with a radial method. The infarct related coronary artery state was assessed by the Thrombosis in Myocardial Infarction grade and the functional characteristics of collateral vessels by Rentrop's classification. These three variables as well as location of myocardial infarction, left ventricular ejection fraction, administration of a thrombolytic therapy, delay between myocardial infarction and monoclonal antibody scintigraphy were studied using non parametric test, or by linear regression method in order to determine whether these factors would influence the heart/lung ratio. None of these parameters except infarct size was related to heart/lung ratio. Consequently, monoclonal antibody uptake is only dependent on the extent of infarcted myocardium and the intensity of uptake cannot predict the patency of an infarct related coronary artery.

Adult↗
PubMed1993

Survey of oral hygiene regimens among bone marrow transplant centers.

Oral complications may occur as an adverse effect of the preparative regimens used in bone marrow transplantation (BMT). A variety of oral-care regimens are used to manage the prevention and treatment of oral complications. The purpose of this descriptive survey was to identify similarities and differences in oral-care regimens among various BMT centers. A 35-item questionnaire was sent to 92 BMT centers, with an 80% response rate. The responses were analyzed using descriptive statistics. Following a variety of guidelines, routine oral assessments were performed by physicians (41%), nurses (33%), and dentists (25%). Thirty-eight percent of the BMT centers used WBC counts as a basis for changing the oral hygiene regimen; 90% used platelet counts. When toothbrushing was discontinued, 50% of the centers used toothettes. In 54% of the centers, flossing was not used in oral hygiene regimens. The two primary mouth-rinses used were chlorhexidine and normal saline. In summary, few similarities existed in the assessment and management of oral care.

Bone Marrow Transplantation↗
PubMed1992

How to induce physicians to engage in quality assurance activities in a university hospital: a policy.

This article reports on a 3-year quality assurance (QA) support activity in the Assistance Publique-Hôpitaux de Paris, a large university hospital system covering the Greater Paris area. This activity stressed the interprofessional and voluntary character of QA. As well as showing the traditional reservations that usually prevent physicians from embracing QA. French physicians have specific problems with the word "evaluation" that has for them greater monetary than scientific connotations. In addition, the above-mentioned reservations are aggravated by the background culture and career structure of university physicians in France. In spite of these initial difficulties the support programme succeeded in getting QA off the ground in 60 departments in 25 hospitals. The need for a well developed medical information system as an incentive for QA activities in AP is discussed.

France↗
PubMed1991

[Evaluation of quality of care in the United States].

Quality assessment in the USA has been undertaken during the past twenty years by different institutions sponsored by the Congress, the government and professional associations. The evaluation tools which were developed reflect both the diversity of the American medical scene fashions in health care management. They evolved from norms to incentives, but each step in this evolution left its marks in the form of regulations, financial incentives and traditions.

Consensus Statements as Topic↗
PubMed1991

[Hospitalization of foreign residents living abroad at the Assistance Publique--hospitals of Paris (1981-1988)].

In 1988, 10,386 foreign patients living abroad were hospitalized in the public Hospitals of "Assistance Publique" in Paris. Specific statistical methods starting from an anonymous file of patients, made it possible to study these hospital stays in terms of patients for each year between 1981 and 1988. Several factors are described: the various origins of the hospitalized patients; the overall decrease in the number of hospitalized patients during the period taken into account, with a detailed analysis for certain nationalities; the comparatively higher rate of tumors and cardiovascular diseases; the distribution of patients by diseases and by geographical origin. These data are in keeping with those of a recent survey on morbidity carried out by the Department of Health.

Ethnicity↗
PubMed1991

[Effects of contrast media products on erythrocyte aggregation. An ex vivo study].

It has been suggested (Fisher and al., Rainiko and al.) that contrast media could interfere with a red blood cell aggregation, low-osmolarity and non ionic contrast media leading to red blood cell aggregates in vitro. Clinical significance of this phenomenon is not known. We have studied 21 consecutive patients admitted in X ray department for pyelography. Sodium and meglumine ioxitalamate (Telebrix 38 R; Guerbet) osmolarity 2 100 mOsm kg--viscosity 8.5 cp at 37 degrees C is used for contrast. Red blood cell aggregation is studied by erythraggregometer Sefam. Samples are collected before (T0), 10 and 30 minutes (T10, T30) after contrast infusion. Hemogram and coagulation parameters are measured in parallel. Results show a significant increase of aggregation times at T10, with a trend towards baseline at T30. Dissociation shear rates follow the same fluctuations. We note a concomitant diminution of both fibrinogen and hematocrit levels, well-correlated with red blood cell aggregation. These results suggest a process of hemodilution which could explain the diminution of red blood cell aggregation with this type of contrast medium.

Adult↗